Endocrine

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THYROIDITIS

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HASHIMOTO THYROIDITIS

SUBACUTE GRANULOMATOUS (DE QUERVAIN) THYROIDITIS

REIDEL FIBROSING THYROIDITIS

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HASHIMOTO THYROIDITIS

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Autoimmune destruction of the thyroid gland; associated with HLA-DRS
Its the Most common cause of hypothyroidism in regions where iodine levels are adequate

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Symptoms of
HASHIMOTO THYROIDITIS

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l. Initially may present as hyperthyroidism (due to follicle damage)
2. Progresses to hypothyroidism; decrease T, and increase TSH
3. Antithyroglobulin and antimicrosomal antibodies are often present (sign of thyroid damage).

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seen on histology
HASHIMOTO THYROIDITIS

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Chronic inflammation with germinal centers and Hurthle cells (eosinophilic
metaplasia of cells that line follicles)

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HASHIMOTO THYROIDITIS
may increase the risk for?

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B-cell (marginal zone) lymphoma; presents as an enlarging
thyroid gland late in disease course

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SUBACUTE GRANULOMATOUS (DE QUERVAIN) THYROIDITIS

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Granulomatous thyroiditis that follows a viral infection
- Tender thyroid with transient hyperthyroidism
- Self-l imited; does not progress to hypothyroidism

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REIDEL FIBROSING THYROIDITIS

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Chronic inflammation with extensive fibrosis of the thyroid gland
Presents as hypothyroidism with a ' hard as wood,' nontender thyroid gland
Fibrosis may extend to involve local structures (e.g., airway).
Clinically mimics anaplastic carcinoma, but patients are younger (40s), and malignant cells are absent

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THYROID NEOPLASIA

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FOLLICULAR ADENOMA
PAPILLARY CARCINOMA
FOLLICULAR CARCINOMA
MEDULLARY CARCINOMA
ANAPLASTIC CARCINOMA

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Thyroid neoplasia
basic principal

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1. Presents as a distinct, solitary nodule
Tyroid nodules are more benign than malignant.
2. iodine radioactive uptake studies are useful to further characterize nodules.
- Increased uptake ('hot' nodule) is seen in Graves disease or nodular goiter.
- Decreased uptake ('cold' nodule) is seen in adenoma and carcinoma; often warrants biopsy
3. Biopsy is performed by fine needle aspiration (FNA).

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Follicular adenoma

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Benign proliferation offollicles surrounded by a fibrous capsule
Nonfunctional; but less commonly, may secrete thyroid hormone

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PAPILLARY CARCINOMA

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1. Most common type of thyroid carcinoma (80% of cases)
2. Exposure to ionizing radiation in childhood is a major risk factor.
3. Comprised of papillae lined by cells with clear, 'Orphan Annie eye' nuclei and nuclear grooves; papillae are often associated with psammoma bodies.
4. Often spreads to cervical (neck) lymph nodes, but prognosis is excellent (10-year survival> 95%)

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FOLLICULAR CARCINOMA

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1. Malignant proliferation of follicles surrounded by a fibrous capsule with invasion through the capsule
- Invasion through the capsule helps distinguish follicular carcinoma from follicular adenoma.
- Entire capsule must be examined microscopically.
- FNA only examines cells and not the capsule; hence, a distinction between follicular adenoma and follicular carcinoma cannot be made by F A.
2. Metastasis generally occurs hematogenously.

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MEDULLARY CARCINOMA

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Malignant proliferation of parafollicular C cells; comprises 5% of thyroid carcinomas
- C cells are neuroendocrine cells that secrete calcitonin.
- Calcitonin lowers serum calcium by increasing renal calcium excretion but is inactive at normal physiologic levels.
- High levels of calcitonin produced by tumor may lead to hypocalcemia.
- Calcitonin often deposits within the tumor as amyloid.
2. Biopsy reveals sheets of malignant cells in an amyloid stroma.
3. Familial cases are often due to multiple endocrine neoplasia (MEN) 2A and 2B,
which are associated with mutations in the RET oncogene.
- MEN 2 results in medullary carcinoma, pheochromocytoma, and parathyroid
adenomas (2A) or ganglioneuromas of the oral mucosa (2B).
- Detection of the RET mutation warrants prophylactic thyroidectomy.

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ANAPLASTIC CARCINOMA

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- Undifferentiated malignant tumor of the thyroid; usually seen in elderly
- Often invades local structures, leading to dysphagia or respiratory compromise
- Poor prognosis